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2005-328a
\ C , INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract" ) entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the S to of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Dasie Bridgewater Hope Center ( Recipient) , of: Dasie Bridgewater Hope Center P . O . Box 701483 Wabasso , Florida 32970 Dasie Hope Center After School Program Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community . B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) , and established the Children ' s Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children ' s Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient , by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract . 2 . Purpose of the Grant. The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes" ) . 3 . Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - \ C , INDIAN RIVER COUNTY GRANT CONTRACT This Grant Contract ("Contract" ) entered into effective this day of October 2005 , by and between Indian River County, a political subdivision of the S to of Florida ; 1840 25th Street , Vero Beach , Florida , 32960-3365 ; and Dasie Bridgewater Hope Center ( Recipient) , of: Dasie Bridgewater Hope Center P . O . Box 701483 Wabasso , Florida 32970 Dasie Hope Center After School Program Background Recitals A. The County has determined that is in the public interest to promote healthy children in a healthy community . B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) , and established the Children ' s Services Advisory Committee to promote healthy children in a healthy community, and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children ' s Services Advisory Committee in fulfilling its purpose . D . The proposal submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient , by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this contract . 2 . Purpose of the Grant. The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient , attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes" ) . 3 . Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2005/2006 ("Grant Period" ) . The Grant Period commences on October 1 , 2005 and ends on September 30 , 2006 . - 1 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : FIFTY EIGHT THOUSAND , SIX HUNDRED SEVENTY THREE DOLLARS ($58 , 673 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient . 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County' s expense , upon five ( 5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that , promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately . The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best , subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : - 2 - 4 . Grant Funds and Payment . The approved Grant for the Grant Period is : FIFTY EIGHT THOUSAND , SIX HUNDRED SEVENTY THREE DOLLARS ($58 , 673 . 00 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for the Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" , attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligation of Recipient . 5 . 1 . Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County' s expense , upon five ( 5 ) days prior to written notice . 5 . 2 . Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws and regulations . 5 . 3 . Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative , Performance Reports to the Human Services Department of the County, within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 and September 30 . 5 .4 . Audit Requirements . If Recipient receives $25 , 000 , or more in aggregate , from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for the prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 . The Recipient further acknowledges that , promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately . The foregoing termination right is in addition to any other right of the County to terminate the Contract . 5 .4 . 2 . The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 . Insurance Requirements . Recipient shall , no later than September 21 , 2005 provide to Indian River County Risk Management Division a certificate , or certificates , issued by an insurer, or insurers , authorized to conduct business in Florida that is rated not-less-than Category A- :VII by A. M . Best , subject to approval by Indian River County' s Risk Manager, of the following types and amounts of insurance : - 2 - (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and ( iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit . ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct , negligent act, or omissions of the Recipient , its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: Thomas S . Lowther, Chairman BCC Approved : / //. © 5:: _ Attest : J . K. Barton , Clerk By : '&'4, V&ei'v Deputy Clerk Approved : Jose WA. Baird , County Administrator Appro d t rm and legal sufficiency: c, a an E . F , Assista o n 4jv •• • • • • • ♦ 4 ' w REIE T : By: Dasie Bridgewater Hope C nter - 4 - (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , product/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non-owned autos and other vehicles ; and ( iii ) Worker's Compensation and Employer's Liability (current Florida statutory limit . ) . 5 . 6 . Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30) calendar days prior written notice having been given the County. In addition , the County may request such other proofs and assurances as it may reasonable require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Worker's Compensation Insurance . The Recipient shall , upon ten ( 10 ) days prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 . Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct , negligent act, or omissions of the Recipient , its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 . Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . - 3 - EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Dasie Bridgewater Hope Center, Inc. PROGRAM COVER PAGE Dasie Bridgewater Hope Center, Inc. Executive Director: Verna Wright E-mail : vwri tg11 561gaol . com Address : 8445 -64th Ave. — P. O . Box 701483 Telephone : 772-589-3535 Wabasoo, FL 32970 Fax : 772-5894688 Program Director: E-mail : Address : Telephone : Fax : Program T ' e: Dasie Hope Center After school Program Priority Need AreaIddressed: Latchkey Safey Programs JR-820.650-45 Brief Description of the Program: This program is designed to help educate and ensure the safety of youngsters who normally would have to stay unsupervised in their homes after school or thoughout the day because their parents are working and child-care is unavailable. SUMMARY REPORT — (Enter Information In The Black Cells Only) Total Program Cost per Client : # DIV / 0 ! r * * If request increased 5 % or more, briefly explain why: More staff is needed to accommodate the increase in student population. If these funds are being used to match another source, name the source and the $ amount : The Organization 's Board of Directors has approved this application on (date). Letitica Whitfield-Hart Name of President/Chair of the Board SiLynature Verna M. Wright , Name of Executive Director/CEO gnature WU 3 IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COMMISSIONERS By: Thomas S . Lowther, Chairman BCC Approved : / //. © 5:: _ Attest : J . K. Barton , Clerk By : '&'4, V&ei'v Deputy Clerk Approved : Jose WA. Baird , County Administrator Appro d t rm and legal sufficiency: c, a an E . F , Assista o n 4jv •• • • • • • ♦ 4 ' w REIE T : By: Dasie Bridgewater Hope C nter - 4 - Dasie Bridgewater Hope Center, Inc . PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . Mission Statement - Offering a nurturing environment where youth and adults can develop their self-esteem and learn life survival skills . Vision — Through a dedicated and commitment from the community, become an agency that is inspiring residents to grow by improving their employability skills , educational skills , and fill them with a sense of self-worth and pride. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Dasie Hope Center was established September 5 , 2001 in memory of Dasie Bridgewater, who was a lifelong resident of Wabasso , who believed strongly in helping the next person . Out of that love and dedication Dasie Hope Center was established, to help youth within the community succeed . Providing programs in areas of expertise such as ; SBI (school of business & industry) , girl scouts, kids kafe, computer training, Benjamin Bannack Math Club , homework tutoring, reading Buddies Superstars , and educational field trips . Accomplishments - Every third-grader (enrolled at Dasie Hope Center) passed the FCAT exam - This year will mark our second youth to assist a high school student(that was enrolled at Dasie Hope Center) to enter college, who otherwise wouldn ' t have gone to college - Dasie Hope Center k- 3 showed a 93 % increase in their spelling and reading since attending our after school tutoring program - Dasie Hope moved into a 4 , 000 sq, ft. building within 2 years of opening our doors , to make room for more youth seeking help , love, understanding, patience, nurturing and life survival skills . - Dasie Hope offered the first full- day summer recreation camp in the Wabasso with attendance to full capacity. Dasie Hope Center serves the North County population with focus on the Wabasso county where there is a dire need for community services . 4 Dasie Bridgewater Hope Center, Inc. Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change ? b) Who has the need ? c) Where do they live ? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. Teen pregnancy, school drop-outs, drug abuse, poor health hygiene & nutrition is a very unacceptable condition facing youth within the Wabasso community ranging in ages 5 - 18 . Without a quality staffed after school program to offer in the place of the above mentioned, youth will become another statistic of society. Studies have shown that in the urban and low- income areas, the vast majority of juvenile crime happens between the hours of 3 pm — 6 pm and that many school districts have found that the traditional school day is inadequate to meet the demands of new educational standards . 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. Other programs dedicated to helping North County residents are : Gifford Youth Activity Center (Gifford) and the Boys & Girl Club (Sebastian) . Many youth do not have the transportation necessary to travel to Gifford or Sebastian . This forces many youth to become latchkey kids without any after school activities or supervision . Dasie Hope Center is located within walking distance for most residents in Wabasso . The programs that Dasie Hope Center offers meet more of the basic needs of youth in the area. Additionally, Dasie Hope Center provides one-on-one (more personalized) service to children. The Center ' s director keeps in contact with parents and teachers of these youth to better identify and meet their individual needs . 5 EXHIBIT A (Copy of complete Request for Proposal ) EXHIBIT - A - Dasie Bridgewater Hope Center, Inc. C . PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Error ! Not a valid link. 2 . Briefly describe program activities including location of services . All programs activities are provided at Dasie Hope Center, 8445 -64th Ave . , Wabasso , FL 32970 Activity Service Result Tutoring (a priority) Teachers/staff provide assistance Better grades in school Reading Superstars Reading clubs for grade & age Reading & comprehension skills will improve SBI Prep Program Business skills, business etiquette, Youth enter college with a 401 k, stocks are taught by business teacher future Interpersonal Skills Volunteer provide good health & personal Good choices that will de- habits , table manners, substance abuse pre- lay sexual activity, good vention, and teen pregnancy prevention career choices that will lead to successful job . 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population . Studies have shown that in urban and low-income areas, after school programs are essential to counteract the effects of a range of factors that can contribute to youth ' s lack of opportunities and ability to succeed academically. Studies have shown that petty crimes that take place during the hours of 3 - 6pm are committed by juveniles with nothing to do after school without adult supervision. 6 Dasie Bridgewater Hope Center, Inc. 4 . List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Staff Director 4 yrs . or more experience 40 hours per wk . Program Director 2 yrs . or more experience 40 hours per week Casework Manager 2 yrs . or more experience 40 hours per week Reading Teacher 4 yrs . of more experience 15 hours per week Volunteers Reading Teacher Teaching experience 2 or more hours per wk . Health Teacher Teaching experience 2 or more hours per wk . PE Teacher Teaching experience 4 or more hours per wk. 5. How will the target population be made aware of the program ? Newsletters , school flyers , local magazines , TV presentations, word-of-mouth, door-to- door recruitment, parent support groups and local churches and club organizations . An orientation of the program will be introduced to the community held at Dasie Hope Center to introduce staff and volunteers . 6 . How will the program be accessible to target population (i. e. , location, transportation, hours of operation) ? Dasie Hope Center is located within walking distance to many of the youth in the community. Youth are transported to the center after school via school buses from school . Parents, or relatives pickup youth from DHC , others are within walking distance . The Center ' s hours are 10 : 00AM- 6 : OOPM, Mon- Fri . 7 Dasie Bridgewater Hope Center, Inc. PROGRAM COVER PAGE Dasie Bridgewater Hope Center, Inc. Executive Director: Verna Wright E-mail : vwri tg11 561gaol . com Address : 8445 -64th Ave. — P. O . Box 701483 Telephone : 772-589-3535 Wabasoo, FL 32970 Fax : 772-5894688 Program Director: E-mail : Address : Telephone : Fax : Program T ' e: Dasie Hope Center After school Program Priority Need AreaIddressed: Latchkey Safey Programs JR-820.650-45 Brief Description of the Program: This program is designed to help educate and ensure the safety of youngsters who normally would have to stay unsupervised in their homes after school or thoughout the day because their parents are working and child-care is unavailable. SUMMARY REPORT — (Enter Information In The Black Cells Only) Total Program Cost per Client : # DIV / 0 ! r * * If request increased 5 % or more, briefly explain why: More staff is needed to accommodate the increase in student population. If these funds are being used to match another source, name the source and the $ amount : The Organization 's Board of Directors has approved this application on (date). Letitica Whitfield-Hart Name of President/Chair of the Board SiLynature Verna M. Wright , Name of Executive Director/CEO gnature WU 3 Dasie Bridgewater Hope Center, Inc . D . MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomesform. This descri tion a e does not need to be included in the ro osal. In order to show the impact that your program is having on the target population and the community, the funders ' are requiring measurable outcomes . Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population . Indicates the results of the services you provide, not the services you provide . Outcomes utilize action words such as maintain, increase, decrease , reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide, operate, and develop . The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline : The number that you will be • Degree of chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75 % (degree of change) in one year (timeframe) as reported by the 2003 School Board attendance records (as measured by) . Baseline : 2003 School Board attendance records for enrolled boys and girls . Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks . Example 2 (Outcome) , 75 % (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (timeframe), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software ; 2) Participants will go through the one lesson per week and be graded for 10 weeks . IMPORTANT NOTE . Keep in mind when developing your PROGRAM OUTCOMES , that if funded, this will be what you are held accountable to accomplish. Also , the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B 1 ) . All Program Need Statements should flow from the Mission & Vision . Measurable Outcomes should be based on and measure program needs . Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement . 8 Dasie Bridgewater Hope Center, Inc . D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To decrease (direction of change) 1 . Conduct Interpersonal skills class, self- disciplinary reports(area of change) of enrolled esteem, anger management, professional youth(target population) by at least 50% development programs to enrolled youth 3x ' s (degree of change) during 2005 -2006 academic per week for 16 wks . year (time frame) . Disciplinary reports generated by the IRC School District (measure by) Baseline : Students 2005 disciplinary report 2 . To increase (direction of change) academic 2 . Conduct group and one-on-one tutorial performance (area of change) to enrolled youth sessions with enrolled youth 4x ' s per week for (target population) by cut at least 20% (degree 36 weeks . Evaluation of current academic of change) during 2005 -2006 academic year performance, develop a self profile (time frame) . Students 2005 academic records performance growth record to show will be compared to their 2005 records improvement. (measure by) Baseline : Students 2005 academic record 3 . To increase (direction of change) knowledge 3 . Conduct basic survival and life management of basic life survival skills (area of change) of skill classes to enrolled youth 3 times per week enrolled youth (target population) by at least for 32 weeks . Financial Management (SBI 50% (degree of change) during the 2005 -2006 Prep Program) will also be conducted 2 times academic year (time frame) . Comparison of per week for 30 weeks for 10- 12 graders which life management class records for 2005 will also include college preparation classes academic year (measure by) (SAT, ACT) . Baseline : Student 2005 Life Management academic reports 9 Dasie Bridgewater Hope Center, Inc . PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . Mission Statement - Offering a nurturing environment where youth and adults can develop their self-esteem and learn life survival skills . Vision — Through a dedicated and commitment from the community, become an agency that is inspiring residents to grow by improving their employability skills , educational skills , and fill them with a sense of self-worth and pride. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Dasie Hope Center was established September 5 , 2001 in memory of Dasie Bridgewater, who was a lifelong resident of Wabasso , who believed strongly in helping the next person . Out of that love and dedication Dasie Hope Center was established, to help youth within the community succeed . Providing programs in areas of expertise such as ; SBI (school of business & industry) , girl scouts, kids kafe, computer training, Benjamin Bannack Math Club , homework tutoring, reading Buddies Superstars , and educational field trips . Accomplishments - Every third-grader (enrolled at Dasie Hope Center) passed the FCAT exam - This year will mark our second youth to assist a high school student(that was enrolled at Dasie Hope Center) to enter college, who otherwise wouldn ' t have gone to college - Dasie Hope Center k- 3 showed a 93 % increase in their spelling and reading since attending our after school tutoring program - Dasie Hope moved into a 4 , 000 sq, ft. building within 2 years of opening our doors , to make room for more youth seeking help , love, understanding, patience, nurturing and life survival skills . - Dasie Hope offered the first full- day summer recreation camp in the Wabasso with attendance to full capacity. Dasie Hope Center serves the North County population with focus on the Wabasso county where there is a dire need for community services . 4 Dasie Bridgewater Hope Center, Inc. Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change ? b) Who has the need ? c) Where do they live ? d) Provide local, state, or national trend data, with reference source, that corroborates that this is an area of need. Teen pregnancy, school drop-outs, drug abuse, poor health hygiene & nutrition is a very unacceptable condition facing youth within the Wabasso community ranging in ages 5 - 18 . Without a quality staffed after school program to offer in the place of the above mentioned, youth will become another statistic of society. Studies have shown that in the urban and low- income areas, the vast majority of juvenile crime happens between the hours of 3 pm — 6 pm and that many school districts have found that the traditional school day is inadequate to meet the demands of new educational standards . 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. Other programs dedicated to helping North County residents are : Gifford Youth Activity Center (Gifford) and the Boys & Girl Club (Sebastian) . Many youth do not have the transportation necessary to travel to Gifford or Sebastian . This forces many youth to become latchkey kids without any after school activities or supervision . Dasie Hope Center is located within walking distance for most residents in Wabasso . The programs that Dasie Hope Center offers meet more of the basic needs of youth in the area. Additionally, Dasie Hope Center provides one-on-one (more personalized) service to children. The Center ' s director keeps in contact with parents and teachers of these youth to better identify and meet their individual needs . 5 Dasie Bridgewater Hope Center, Inc . OUTCOMES ACTIVITIES Add all of the elements for your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 10 Dasie Bridgewater Hope Center, Inc. E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters.) Collaborative Agency Resources provided to the program Volunteerism, Youth Christmas party Disney Resort of Vero Beach Reading materials , Reading teacher, FCAT material• , Indian River School District guest speakers Program Sponsor, Volunteerism • Grand Harbor Giving Foundation Crime Prevention, Drug Awareness Indian River County Sheriff Department Provides new books monthly Vero Beach Book Store Volunteerism Orchid Island Rotary Club Sponsor Girl Scout, Volunteerism, and fundraise The Hill Group , Charlotte Terry Realty Volunteerism, support, books for library, playground Community Church of Vero Beach installed Building space Indian River County Commissioners 11 Dasie Bridgewater Hope Center, Inc. C . PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Error ! Not a valid link. 2 . Briefly describe program activities including location of services . All programs activities are provided at Dasie Hope Center, 8445 -64th Ave . , Wabasso , FL 32970 Activity Service Result Tutoring (a priority) Teachers/staff provide assistance Better grades in school Reading Superstars Reading clubs for grade & age Reading & comprehension skills will improve SBI Prep Program Business skills, business etiquette, Youth enter college with a 401 k, stocks are taught by business teacher future Interpersonal Skills Volunteer provide good health & personal Good choices that will de- habits , table manners, substance abuse pre- lay sexual activity, good vention, and teen pregnancy prevention career choices that will lead to successful job . 3 . Briefly describe how your program addresses the stated need/problem. Describe how your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population . Studies have shown that in urban and low-income areas, after school programs are essential to counteract the effects of a range of factors that can contribute to youth ' s lack of opportunities and ability to succeed academically. Studies have shown that petty crimes that take place during the hours of 3 - 6pm are committed by juveniles with nothing to do after school without adult supervision. 6 Dasie Bridgewater Hope Center, Inc. 4 . List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). Staff Director 4 yrs . or more experience 40 hours per wk . Program Director 2 yrs . or more experience 40 hours per week Casework Manager 2 yrs . or more experience 40 hours per week Reading Teacher 4 yrs . of more experience 15 hours per week Volunteers Reading Teacher Teaching experience 2 or more hours per wk . Health Teacher Teaching experience 2 or more hours per wk . PE Teacher Teaching experience 4 or more hours per wk. 5. How will the target population be made aware of the program ? Newsletters , school flyers , local magazines , TV presentations, word-of-mouth, door-to- door recruitment, parent support groups and local churches and club organizations . An orientation of the program will be introduced to the community held at Dasie Hope Center to introduce staff and volunteers . 6 . How will the program be accessible to target population (i. e. , location, transportation, hours of operation) ? Dasie Hope Center is located within walking distance to many of the youth in the community. Youth are transported to the center after school via school buses from school . Parents, or relatives pickup youth from DHC , others are within walking distance . The Center ' s hours are 10 : 00AM- 6 : OOPM, Mon- Fri . 7 Dasie Bridgewater Hope Center, Inc . F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H ? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Daily youth participation, and attendance is tracked through sign-in attendance . Academic performance is tracked via report cards produced by Indian River School District. An initial application process is taken where age, gender, ethnic background, school lunch program , address and reside with are priority questions to determine qualification for services at Dasie Hope Center. Low income, school lunch program (from school) , failing grades in school , and attendance problem are the key pieces for qualifying for Dasie Hope Center. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores , attendance, absences, skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? A pre test is given at the entry into a non-academic activity and post a test is given at the completion of the program . Report cards from the Indian River School District is our first baseline measuring tool for a failing student, the same for their attendance report . Last, a home visit is made to (if possible) talk with the parent or guardian and get signed documents to receive information from school . Academic achievement is based on improvement in school . Non- academic achievement is based on performance at on- site and off-site settings , along with post tests . 12 Dasie Bridgewater Hope Center, Inc . I REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? Quarterly reports are given to Children ' s Service Advisory Committee, quarterly reports given to board members , staff give reports to Director. Students that show improvement and great achievement are highlighted in the Center ' s newsletter and this information is shared with funders and parents . An award ceremony is held for youth at the end of the school (which builds their confidence and self-esteem) with family and friends in attendance . Older youth (who have made improvement in attendance, behavior and academic grades) are encouraged to become "peer monitors" to younger students . 13 Dasie Bridgewater Hope Center, Inc . D . MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomesform. This descri tion a e does not need to be included in the ro osal. In order to show the impact that your program is having on the target population and the community, the funders ' are requiring measurable outcomes . Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population . Indicates the results of the services you provide, not the services you provide . Outcomes utilize action words such as maintain, increase, decrease , reduce, improve, raise and lower. ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes . Activities utilize action words such as complete, establish, create, provide, operate, and develop . The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline : The number that you will be • Degree of chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75 % (degree of change) in one year (timeframe) as reported by the 2003 School Board attendance records (as measured by) . Baseline : 2003 School Board attendance records for enrolled boys and girls . Example 1 (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks . Example 2 (Outcome) , 75 % (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (timeframe), will improve (direction of change) their scores in one or more subject area (area of change) . 25 % of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software ; 2) Participants will go through the one lesson per week and be graded for 10 weeks . IMPORTANT NOTE . Keep in mind when developing your PROGRAM OUTCOMES , that if funded, this will be what you are held accountable to accomplish. Also , the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B 1 ) . All Program Need Statements should flow from the Mission & Vision . Measurable Outcomes should be based on and measure program needs . Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement . 8 Dasie Bridgewater Hope Center, Inc . D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To decrease (direction of change) 1 . Conduct Interpersonal skills class, self- disciplinary reports(area of change) of enrolled esteem, anger management, professional youth(target population) by at least 50% development programs to enrolled youth 3x ' s (degree of change) during 2005 -2006 academic per week for 16 wks . year (time frame) . Disciplinary reports generated by the IRC School District (measure by) Baseline : Students 2005 disciplinary report 2 . To increase (direction of change) academic 2 . Conduct group and one-on-one tutorial performance (area of change) to enrolled youth sessions with enrolled youth 4x ' s per week for (target population) by cut at least 20% (degree 36 weeks . Evaluation of current academic of change) during 2005 -2006 academic year performance, develop a self profile (time frame) . Students 2005 academic records performance growth record to show will be compared to their 2005 records improvement. (measure by) Baseline : Students 2005 academic record 3 . To increase (direction of change) knowledge 3 . Conduct basic survival and life management of basic life survival skills (area of change) of skill classes to enrolled youth 3 times per week enrolled youth (target population) by at least for 32 weeks . Financial Management (SBI 50% (degree of change) during the 2005 -2006 Prep Program) will also be conducted 2 times academic year (time frame) . Comparison of per week for 30 weeks for 10- 12 graders which life management class records for 2005 will also include college preparation classes academic year (measure by) (SAT, ACT) . Baseline : Student 2005 Life Management academic reports 9 Dasie Bridgewater Hope Center, Inc . G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities 14 Dasie Bridgewater Hope Center, Inc . June Report cards reviewed . Summer recreation camp begins . Reading & Math is included in camp 3 times a week . Recreational activities and field trips July Summer recreation camp continues . At end of camp awards are given and a picnic is planned . August Summer recreation ends . Back-to-school supplies are given out(week before school starts back) . Parents are invited to come out to meet staff and volunteers , youth are encouraged to have a GREAT YEAR ! ! September Mentoring matching begins . Youth begin computer classes . Student one-on-one interviews begin. SBI (School of Business & Industry) have "Orientation Night", parents and sponsors are invited to meet each October other. Progress reports are reviewed . Parent support group begin . Reading buddies club starts . Can good drive starts (Thanksgiving baskets) November Thanksgiving baskets are given out to elderly. Thanksgiving dinner is prepared at Center by youth (Kidz Kafe) . Youth start producing calendar(which goes on sale in Jan . ) December Community Holiday fundraiser (Wabasso Everyday Hero) . Disney Resort Christmas party (for youth enrolled at Dasie Hope Center) . Youth finish up calendars . January Semester exam study sessions meet weekly (3 times a week) . FCAT tutoring begins . February FCAT tutoring continues . Report card review . Volunteer/Donor Appreciation event (kidz kafe sponsor at Center) . Black History play at Center. March SBI students visit a college. FCAT testing in school . Dasie Hope FCAT testing . April Crabfest fundraiser. SBI students take major trip . College car wash May (funds go to high school graduate enrolled at Dasie Hope) FCAT results back. Award ceremony "GOOD JOB " . SBI student graduation ceremony (parents and sponsors invited) . Senior report cards reviewed . 15 Dasie Bridgewater Hope Center, Inc . OUTCOMES ACTIVITIES Add all of the elements for your Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 10 Dasie Bridgewater Hope Center, Inc. E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters.) Collaborative Agency Resources provided to the program Volunteerism, Youth Christmas party Disney Resort of Vero Beach Reading materials , Reading teacher, FCAT material• , Indian River School District guest speakers Program Sponsor, Volunteerism • Grand Harbor Giving Foundation Crime Prevention, Drug Awareness Indian River County Sheriff Department Provides new books monthly Vero Beach Book Store Volunteerism Orchid Island Rotary Club Sponsor Girl Scout, Volunteerism, and fundraise The Hill Group , Charlotte Terry Realty Volunteerism, support, books for library, playground Community Church of Vero Beach installed Building space Indian River County Commissioners 11 Dasie Bridgewater Hope Center, Inc . H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Last Fiscal ears , Current Fiscal Year icalYear Location Actui !02/20t Budget 2004/05 Y' ojos aQ4lOS; Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County - 85 100 S . Indian River County - - - Indian River Co. Total - 85 100 Greater Stuart - - - Hobe Sound - - - Indiantown - - Jensen Beach - - Palm City - - Martin County Total - - Fort Pierce Port Saint Lucie - - St. Lucie Co. Total Other Locations TOTAL SERVED - 85 100 Number of Unduplicated Clients by Age a ` VV Ste` S Last ; iscal �e�r � " Current Fiscal Year caI �eaar Location µh Actual �?{ /20Q Budget 2004/05 of ons 205/06 ludo t ua s GyTr6un Individual Group Aua� di t um G roup 0 to 4 - (Pre-school) 5 to 10 - (Elementary) - - - - 23 _ 11 to 14 - (Middle) - - - - 37 - 15 to 18 - (High School) - - 85 - 40 - Total Children - - 85 - 100 - 19 to 59 - (Adults) - - - - - 60 + ( Seniors) Total Adults - - - - - - TOTAL SERVED - - 85 - 100 - 16 Edit this Header. Type the organization and program name and the funder for whom it is being completed . The page # is already set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. " Core Budget Forms " 17 Dasie Bridgewater Hope Center, Inc . F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H ? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Daily youth participation, and attendance is tracked through sign-in attendance . Academic performance is tracked via report cards produced by Indian River School District. An initial application process is taken where age, gender, ethnic background, school lunch program , address and reside with are priority questions to determine qualification for services at Dasie Hope Center. Low income, school lunch program (from school) , failing grades in school , and attendance problem are the key pieces for qualifying for Dasie Hope Center. 2 . MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores , attendance, absences, skill levels) for your program? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? A pre test is given at the entry into a non-academic activity and post a test is given at the completion of the program . Report cards from the Indian River School District is our first baseline measuring tool for a failing student, the same for their attendance report . Last, a home visit is made to (if possible) talk with the parent or guardian and get signed documents to receive information from school . Academic achievement is based on improvement in school . Non- academic achievement is based on performance at on- site and off-site settings , along with post tests . 12 Dasie Bridgewater Hope Center, Inc . 3 . REPORTING : What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the program, and the community? How will you use this information to improve your program ? Quarterly reports are given to Children ' s Service Advisory Committee, quarterly reports given to board members , staff give reports to Director. Students that show improvement and great achievement are highlighted in the Center ' s newsletter and this information is shared with funders and parents . An award ceremony is held for youth at the end of the school (which builds their confidence and self-esteem) with family and friends in attendance . Older youth (who have made improvement in attendance, behavior and academic grades) are encouraged to become "peer monitors" to younger students . 13 Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : DASIE BRIDGEWATER HOPE CENTER , INC . FUNDER : CHILDREN ; S SERVICES ADVISORY COMMITTEE I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should 1 �` used for calculations and to write information only. GRAY AGENCY USE ONLY Proposed Total Program Funder Specific Total Agency REVENUES AGENCY USE ONLY (sHow DETAIL a CALCULATIONS) Budget Budget Budget 1 Children's Services Council -St. Lucie 2 Children's Services Council -Martin 3 Advisory Committee-Indian River 803000 .00 80, 000. 00 80,000 . 00 4 United Way-St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 60 , 000 . 00 60 , 000 . 00 7 Department of Children & Families 8 County Funds 9 Contributions-Cash 60 , 037 .64 60 , 037 . 64 10 Program Fees 1 ,500. 00 1 , 500 . 00 11 Fund Raising Events-Net 61000 . 00 61000. 00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 3 ,000 . 00 31000 . 00 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $210 ,537 .64 $80 ,000 . 00 $210 , 537. 64 A B C D EXPENDITURES GRAYAREASFOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY )SHOW CALCULATIONS) Budget Budget Budget 21 Salaries - ( must complete chart on next page) 129 ,680 . 00 613090 . 00 129,680 . 00 0 Salary 22 FICA - Total salaries x 0.0765 7.65% 91920 . 52 41673 . 39 90920 . 52 e firemen - nnua pension or qualified 23 staff 0 . 00 Life/Health - e Ica enta ort-term 24 Disab. 2,004 . 00 0. 00 21004 . 00 Workers Compensation - # emp oyees x 25 rate 41437 . 12 29261 . 24 4 ,437 . 12 1- ioncla Unemployment - # projected 26 employees x $7 , 000 x UCT-6 rate 945 . 00 756 . 00 945 . 00 SALARIES A o Gross Annual B C % of Gross Annual POSITION LISTING Salary Portion of Salary on Proposed Funder Speck Budget Salary (Agency)Position Title / Total Hrs/wk ( Program Y) Requested(C/A) Example: Executive Director / 40hrs 70, 000. 00 10,000. 00 1 5, 000. 00 7. 14% 5/17/2005 B-1 Type the Organization and Program Name Director/40 hrs . 47, 500. 00 47 ,500 . 00 23,750 .00 50 . 00% Program Director/40 hrs . 319000 .00 31 ,000. 00 0. 00 % Case Manger/40 hrs. 25,000. 00 259000 . 00 20 ,000 . 00 80 . 00% Reading Teacher ( Parttime) 20 hrs . 8, 500 .00 8,500 . 00 8500 . 00 100 . 00% Secretary/40hrs 17 ,680. 00 17 ,680. 00 81840 . 00 50 . 00% #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0! Remaining positions throughout the agency Total Salaries $ 129,680 .00 $ 129,680 . 00 $61 ,090 . 00 4711 % . FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B o E F c Specific FICA 7.65% Pension Health Ins. Worker's lJnemployme Total Fringes Funder (A x %) Compens. nt Compens. Column C only, from line 22 to 27) Budget Specific Position Title/ Total Hrs/wk Example: Case Manager / 40 hrs 51000.00 382. 50200,001 500. 00 300.00 200. 00 1, 582. 50 Director/40 hrs. 23 ,750 .00 11816. 88 812 .63 189. 00 2 , 818. 51 Program Director/40 hrs. 0 . 00 0. 00 0 . 00 Case Manger/40 hrs. 20 ,000 .00 1 , 530 .00 855. 30 789. 00 21574 . 30 Reading Teacher (Parttime) 20 hrs . 81500. 00 650.25 290.84 189. 00 11130. 0 Secretary/40hrs 8, 840 . 00 676 .261 302 .47 189. 00 11167 . 73 0 0. 00 0. 00 0 . 00 0 0 . 00 0 .00 0 . 00 0 0. 00 0. 00 0. 00 0 0 . 00 0 . 00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 . 00 0.00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0. 00 0. 00 0 . 00 0 0 .00 0 .00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 .00 0 .00 0 . 00 0 0. 00 0. 00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 . 00 0 .00 0 . 00 0 0. 001 0. 00f 0 . 00 Total Funder Request Fringe Benefits $61 , 090. 001 $4 , 673 .391 $0. 001 $0. 001 $2 , 261 .241 $756. 00 $7, 690 . 63 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb, 28 Travel/ConferencesfTraining 3 , 000. 00i 31000 . 00 5/17/2005 s.i Dasie Bridgewater Hope Center, Inc . G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities, or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Month/Period Activities 14 Dasie Bridgewater Hope Center, Inc . June Report cards reviewed . Summer recreation camp begins . Reading & Math is included in camp 3 times a week . Recreational activities and field trips July Summer recreation camp continues . At end of camp awards are given and a picnic is planned . August Summer recreation ends . Back-to-school supplies are given out(week before school starts back) . Parents are invited to come out to meet staff and volunteers , youth are encouraged to have a GREAT YEAR ! ! September Mentoring matching begins . Youth begin computer classes . Student one-on-one interviews begin. SBI (School of Business & Industry) have "Orientation Night", parents and sponsors are invited to meet each October other. Progress reports are reviewed . Parent support group begin . Reading buddies club starts . Can good drive starts (Thanksgiving baskets) November Thanksgiving baskets are given out to elderly. Thanksgiving dinner is prepared at Center by youth (Kidz Kafe) . Youth start producing calendar(which goes on sale in Jan . ) December Community Holiday fundraiser (Wabasso Everyday Hero) . Disney Resort Christmas party (for youth enrolled at Dasie Hope Center) . Youth finish up calendars . January Semester exam study sessions meet weekly (3 times a week) . FCAT tutoring begins . February FCAT tutoring continues . Report card review . Volunteer/Donor Appreciation event (kidz kafe sponsor at Center) . Black History play at Center. March SBI students visit a college. FCAT testing in school . Dasie Hope FCAT testing . April Crabfest fundraiser. SBI students take major trip . College car wash May (funds go to high school graduate enrolled at Dasie Hope) FCAT results back. Award ceremony "GOOD JOB " . SBI student graduation ceremony (parents and sponsors invited) . Senior report cards reviewed . 15 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging , registration , food ) 29 Office Supplies 1 , 500 . 00 500. 00 1 , 500 . 00 • Office supplies ( monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 2,500. 00 2 ,000 . 00 21500 . 00 • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 500 . 00 500. 00 500 . 00 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 32 Utilities 3,500 . 00 1 ,419 . 37 3 , 500 . 00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 1 . 00 1 . 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 11000 . 00 500 .00 1 ,000 . 00 • Quarterly Newsletter ($ x 4) • Letterheads , Envelopes , etc. • Fundraising materials • Other 35 Subscription/Dues/Memberships 300.00 300. 00 300 . 00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance 6,000 . 00 3t000 . 00 61000. 00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins . • Auto Insurance 37 Equipment : Rental & Maintenance 2 ,000 . 00 500 . 00 21000 . 00 • Copier lease ($ x 12 months ) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months ) • Other 38 Advertising 1 ,000 .00 500 . 00 11000 . 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 8,000 .00 80000. 00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal , Consulting) 81000 . 00 8 ,000 . 00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 81500. 00 8 , 500 . 00 • Books/videos • Materials ($ x staff) 5/17/2005 s.i Type the Organization and Program Name 42 Food & Nutrition 4 , 000 . 00 41000 . 00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 21000 .00 21000 . 00 21000 . 00 Admin . Cost (% of total budget) 44 Audit Expense 8,000. 00 82000 . 00 Independent Audit Review 45 Specific Assistance to Individuals 1 ,000 . 00 11000 . 00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 750 .00 750 . 00 • Background check/drug test • Other 47 Other/Contract 23000. 00 2 , 000 . 00 Sub-contract for program services 48 TOTAL EXPENSES $210,537.64 $80 , 000. 00 $210 , 537 . 64 5/17/2005 B-1 Dasie Bridgewater Hope Center, Inc . H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Last Fiscal ears , Current Fiscal Year icalYear Location Actui !02/20t Budget 2004/05 Y' ojos aQ4lOS; Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County - 85 100 S . Indian River County - - - Indian River Co. Total - 85 100 Greater Stuart - - - Hobe Sound - - - Indiantown - - Jensen Beach - - Palm City - - Martin County Total - - Fort Pierce Port Saint Lucie - - St. Lucie Co. Total Other Locations TOTAL SERVED - 85 100 Number of Unduplicated Clients by Age a ` VV Ste` S Last ; iscal �e�r � " Current Fiscal Year caI �eaar Location µh Actual �?{ /20Q Budget 2004/05 of ons 205/06 ludo t ua s GyTr6un Individual Group Aua� di t um G roup 0 to 4 - (Pre-school) 5 to 10 - (Elementary) - - - - 23 _ 11 to 14 - (Middle) - - - - 37 - 15 to 18 - (High School) - - 85 - 40 - Total Children - - 85 - 100 - 19 to 59 - (Adults) - - - - - 60 + ( Seniors) Total Adults - - - - - - TOTAL SERVED - - 85 - 100 - 16 Edit this Header. Type the organization and program name and the funder for whom it is being completed . The page # is already set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. " Core Budget Forms " 17 11 : 13 AM DASIE BRIDGEWATER HOPE CENTER INC 05/17/05 Profit & Loss by Class Accrual Basis January through April 2005 Basketball Camp Business Program Crab Fest Operating Fund TOTAL Income General Donations 0.00 0 . 00 0 . 00 13 ,599. 88 133599 . 88 Grants Grand Harbor 0. 00 82000 . 00 0.00 0 . 00 81000 . 00 Indian River County 0. 00 0 . 00 0.00 14, 113 . 01 14 , 113 . 01 Johns Island Service League 0. 00 0 . 00 0 . 00 10,000 . 00 10 ,000 . 00 United Way 0. 00 0 . 00 0. 00 14,666 . 64 14 , 666. 64 Total Grants 0 .00 81000 .00 0 .00 38, 779 . 65 46 ,779 . 65 Interest Income 0.00 0. 00 0.00 30 .41 30 .41 Sponsors 0. 00 0. 00 1 ,750 .00 0 . 00 13750 . 00 Ticket Sales 0.00 0 . 00 11136 . 00 0 . 00 11136. 00 Total Income 0 .00 81000 . 00 21886 . 00 52 ,409.94 63 , 295 . 94 Expense Advertising 0. 00 0.00 50.00 0 . 00 50 . 00 Awards & Plaques 0 . 00 0.00 0.00 43 . 00 43 . 00 Bank Charges 0 .00 0.00 0 .00 1 . 03 1 . 03 Books & Educational Materials 0 . 00 68. 84 0 . 00 25 . 80 94 . 64 Dues & Subscriptions 0 . 00 0. 00 0 . 00 95. 60 95 . 60 Equipment 0 . 00 0 . 00 0 . 00 49 . 97 49. 97 Equipment Lease 0 . 00 0 . 00 0 . 00 10 .22 10 . 22 Equipment Rental 0.00 0 .00 65 .00 36.00 101 . 00 Food 0. 00 48.46 21955. 12 874.46 3 , 878 . 04 Fundraising Expense 0. 00 0 . 00 0 . 00 589.72 589. 72 Insurance 0. 00 0 . 00 0 . 00 59838 .72 51838. 72 Office Supplies 0. 00 0 . 00 0 . 00 11486 . 03 1 ,486.03 Payroll Expenses 0 .00 0 . 00 0 . 00 0. 00 0 .00 Payroll Tax Expense 0 . 00 0 . 00 0 . 00 41283 . 27 4 ,283 .27 Playground 0.00 0 . 00 0 . 00 19351 .25 11351 .25 Professional Fees 0.00 0 . 00 0 . 00 250. 00 250.00 Repairs & Maintenance 0 . 00 0 . 00 0.00 10976.27 11976.27 Salaries - Other 0 . 00 0.00 0 .00 40, 171 .58 40 , 171 . 58 Specific Assistance to Individu 0 . 00 0 .00 0 . 00 400 . 00 400 . 00 Supplies 655 . 38 175.00 379. 23 739. 01 11948 . 62 Taxes & Licesnses 0. 00 0 . 00 0 . 00 137 . 50 137 .50 Telephone 0. 00 0 . 00 0 . 00 671 . 04 671 . 04 Transportation 0.00 0 . 00 0 . 00 20 . 00 20 .00 Travel 0 . 00 21412. 67 0 . 00 21178 . 26 41590 . 93 Tutor 0 .00 0 .00 0. 00 377. 00 377 . 00 Unknown 0 . 00 0 . 00 0 .00 271 .00 271 . 00 Utilities 0. 00 0 . 00 0 . 00 820.66 820. 66 Total Expense 655 . 38 21704 . 97 39449. 35 62 ,697 . 39 69, 507 . 09 Net Income -655.38 5,295. 03 -563. 35 -10,287.45 -6,211 . 15 Pagel 11 : 13 AM DASIE BRIDGEWATER HOPE CENTER INC 05/17/05 Balance Sheet Accrual Basis As of April 30 , 2005 Apr 30 , 05 ASSETS Current Assets Checking/Savings Checking - IRNB 823 . 78 Checking - Savings 19, 147.65 Total Checking/Savings 19, 971 .43 Other Current Assets Accounts Receivable 500 .00 Petty Cash 11360. 00 Total Other Current Assets 1 , 860 . 00 Total Current Assets 21 , 831 .43 Fixed Assets Computers 11649. 52 Furniture 81031 . 01 Machinery & Equipment 5, 376. 00 Total Fixed Assets 15, 056. 53 Other Assets Security Deposit 240 . 00 Total Other Assets 240. 00 TOTAL ASSETS 37, 127. 96 LIABILITIES & EQUITY Liabilities Current Liabilities Other Current Liabilities FWT & SS Payable 21413 . 78 Payroll Liabilities -222.42 Total Other Current Liabilities 21191 .36 Total Current Liabilities 2, 191 . 36 Total Liabilities 21191 . 36 Equity Retained Earnings 41 , 147. 75 Net Income -6, 211 . 15 Total Equity 34 , 936. 60 TOTAL LIABILITIES & EQUITY 37, 127.96 Page 1 Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : DASIE BRIDGEWATER HOPE CENTER , INC . FUNDER : CHILDREN ; S SERVICES ADVISORY COMMITTEE I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should 1 �` used for calculations and to write information only. GRAY AGENCY USE ONLY Proposed Total Program Funder Specific Total Agency REVENUES AGENCY USE ONLY (sHow DETAIL a CALCULATIONS) Budget Budget Budget 1 Children's Services Council -St. Lucie 2 Children's Services Council -Martin 3 Advisory Committee-Indian River 803000 .00 80, 000. 00 80,000 . 00 4 United Way-St. Lucie County 5 United Way-Martin County 6 United Way-Indian River County 60 , 000 . 00 60 , 000 . 00 7 Department of Children & Families 8 County Funds 9 Contributions-Cash 60 , 037 .64 60 , 037 . 64 10 Program Fees 1 ,500. 00 1 , 500 . 00 11 Fund Raising Events-Net 61000 . 00 61000. 00 12 Sales to Public - Net 13 Membership Dues 14 Investment Income 15 Miscellaneous 16 Legacies & Bequests 17 Funds from Other Sources 3 ,000 . 00 31000 . 00 18 Reserve Funds Used for Operating 19 In-Kind Donations (Not included in total) 20 TOTAL REVENUES (doesn't include line 19) $210 ,537 .64 $80 ,000 . 00 $210 , 537. 64 A B C D EXPENDITURES GRAYAREASFOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY )SHOW CALCULATIONS) Budget Budget Budget 21 Salaries - ( must complete chart on next page) 129 ,680 . 00 613090 . 00 129,680 . 00 0 Salary 22 FICA - Total salaries x 0.0765 7.65% 91920 . 52 41673 . 39 90920 . 52 e firemen - nnua pension or qualified 23 staff 0 . 00 Life/Health - e Ica enta ort-term 24 Disab. 2,004 . 00 0. 00 21004 . 00 Workers Compensation - # emp oyees x 25 rate 41437 . 12 29261 . 24 4 ,437 . 12 1- ioncla Unemployment - # projected 26 employees x $7 , 000 x UCT-6 rate 945 . 00 756 . 00 945 . 00 SALARIES A o Gross Annual B C % of Gross Annual POSITION LISTING Salary Portion of Salary on Proposed Funder Speck Budget Salary (Agency)Position Title / Total Hrs/wk ( Program Y) Requested(C/A) Example: Executive Director / 40hrs 70, 000. 00 10,000. 00 1 5, 000. 00 7. 14% 5/17/2005 B-1 Type the Organization and Program Name Director/40 hrs . 47, 500. 00 47 ,500 . 00 23,750 .00 50 . 00% Program Director/40 hrs . 319000 .00 31 ,000. 00 0. 00 % Case Manger/40 hrs. 25,000. 00 259000 . 00 20 ,000 . 00 80 . 00% Reading Teacher ( Parttime) 20 hrs . 8, 500 .00 8,500 . 00 8500 . 00 100 . 00% Secretary/40hrs 17 ,680. 00 17 ,680. 00 81840 . 00 50 . 00% #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0! Remaining positions throughout the agency Total Salaries $ 129,680 .00 $ 129,680 . 00 $61 ,090 . 00 4711 % . FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder B o E F c Specific FICA 7.65% Pension Health Ins. Worker's lJnemployme Total Fringes Funder (A x %) Compens. nt Compens. Column C only, from line 22 to 27) Budget Specific Position Title/ Total Hrs/wk Example: Case Manager / 40 hrs 51000.00 382. 50200,001 500. 00 300.00 200. 00 1, 582. 50 Director/40 hrs. 23 ,750 .00 11816. 88 812 .63 189. 00 2 , 818. 51 Program Director/40 hrs. 0 . 00 0. 00 0 . 00 Case Manger/40 hrs. 20 ,000 .00 1 , 530 .00 855. 30 789. 00 21574 . 30 Reading Teacher (Parttime) 20 hrs . 81500. 00 650.25 290.84 189. 00 11130. 0 Secretary/40hrs 8, 840 . 00 676 .261 302 .47 189. 00 11167 . 73 0 0. 00 0. 00 0 . 00 0 0 . 00 0 .00 0 . 00 0 0. 00 0. 00 0. 00 0 0 . 00 0 . 00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 . 00 0.00 0 . 00 0 0 . 00 0 . 00 0. 00 0 0. 00 0. 00 0 . 00 0 0 .00 0 .00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 .00 0 .00 0 . 00 0 0. 00 0. 00 0 . 00 0 0. 00 0. 00 0 . 00 0 0 . 00 0 .00 0 . 00 0 0. 001 0. 00f 0 . 00 Total Funder Request Fringe Benefits $61 , 090. 001 $4 , 673 .391 $0. 001 $0. 001 $2 , 261 .241 $756. 00 $7, 690 . 63 A B C D EXPENDITURES GRAY AREAS FOR Proposed Total Program Funder Specific Total Agency AGENCY USE ONLY TO SHOW DETAIL Budget Budget Budget 27 Travel-Daily # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily Travel/Mileage Reimb, 28 Travel/ConferencesfTraining 3 , 000. 00i 31000 . 00 5/17/2005 s.i EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement , hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - I EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Dasie Bridgewater Hope Center P . O . Box 701483 Wabasso , Florida 32970 2 . Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement . This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent , this Contract is deemed severable . 5 . Captions and Interpretations . Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract . The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient 's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County . EXHIBIT - C - Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cost per staff) • Other Trainings (cost of travel , lodging , registration , food ) 29 Office Supplies 1 , 500 . 00 500. 00 1 , 500 . 00 • Office supplies ( monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone 2,500. 00 2 ,000 . 00 21500 . 00 • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 31 Postage/Shipping 500 . 00 500. 00 500 . 00 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 32 Utilities 3,500 . 00 1 ,419 . 37 3 , 500 . 00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) • Garbage ($ x 12 months) 33 Occupancy (Building & Grounds) 1 . 00 1 . 00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes 34 Printing & Publications 11000 . 00 500 .00 1 ,000 . 00 • Quarterly Newsletter ($ x 4) • Letterheads , Envelopes , etc. • Fundraising materials • Other 35 Subscription/Dues/Memberships 300.00 300. 00 300 . 00 • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines , etc. 36 Insurance 6,000 . 00 3t000 . 00 61000. 00 • Directors/Officers Liab. • Commercial/General Insurance • Bond Ins . • Auto Insurance 37 Equipment : Rental & Maintenance 2 ,000 . 00 500 . 00 21000 . 00 • Copier lease ($ x 12 months ) • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months ) • Other 38 Advertising 1 ,000 .00 500 . 00 11000 . 00 • Newspaper ads • Fundraising ads/promotions • Other (vacancies) 39 Equipment Purchases : Capital Expense 8,000 .00 80000. 00 • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal , Consulting) 81000 . 00 8 ,000 . 00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 Books/Educational Materials 81500. 00 8 , 500 . 00 • Books/videos • Materials ($ x staff) 5/17/2005 s.i Type the Organization and Program Name 42 Food & Nutrition 4 , 000 . 00 41000 . 00 • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs 21000 .00 21000 . 00 21000 . 00 Admin . Cost (% of total budget) 44 Audit Expense 8,000. 00 82000 . 00 Independent Audit Review 45 Specific Assistance to Individuals 1 ,000 . 00 11000 . 00 • Medical assistance • Meals/Food • Rent Assistance • Other 46 Other/Miscellaneous 750 .00 750 . 00 • Background check/drug test • Other 47 Other/Contract 23000. 00 2 , 000 . 00 Sub-contract for program services 48 TOTAL EXPENSES $210,537.64 $80 , 000. 00 $210 , 537 . 64 5/17/2005 B-1 10 - Z $ ' U5 FRI 10 ; 37 FAX 7722311413 FELTEN & ASSOC , 0 (12 ' jQRA CERTIFICATE OF LIA13ILITY INSURANCE � i�rmw� �n _ . . PNOouCEn (772) 231 w2021 FAX 772) 231 -4413 THIS CERTIFICATE IS ISSIUEU AS A 04ATTER OF INFORMATION Fel ten & Asso"ciates" ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7911. Cardinal Drive (32963) HOLAER. THIS CERTIFICATE DOES NOT AMEND) EXTEND OR P . O : Box 3488 ALTER TNS Gt1 TRAGF AFFC)RDED NIX THE POLICES BELOW. Vera Bleach , FL 32964-3488 INSURERS AFFORDING COVERAGE NAiC 0 Iwsur ,� Bwidaater Floe Center Inc _ --�-- ------ — _ _-_ ----- ---i..- ._ _ __ IN5URERA: Colorry Insurance Company pan 8445 64th Ave _.�. _. -.. - - - _ INs �RB Florida Retail Federation Wabasso , FL 32970 - INsUCPRC 171E POLICIES OF IYSUI RANGE USTED BELOW itAVE BEEN ISSUED TO THE INSURED NAMP Ab(AvE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANID(NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WHICH THIS CER71FICATE MAY 8F ISSUIF0 OR MAY MRTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E)(CLUSIONS AND CONDITIONS OF SUCH POLICIES,. AGGREGATE LIMITS_ SHOWN MA.Y HAVE BEEN RFDUCF0 BY PAD C4ANS. 11I�R — 7YP4 OF INSURANCE POLICY NUMIBf3f POMICY T- L Mrr$ 1 GENERALUABUffY ._.. -�._. - - AETS08042 1241231266V11 ail z00 's eA~MOCC $ —J, 000 , 0 X 0OWERCLAL Ct1YERAt L ABILITY DAMAGE TO RENTT D 0001 �Lftffi MADE F l OCCUR MED Ftp (F�ryore F•araan) J( � li1F A X 5000 ded per ,claim PeRsoweLa ADV NJUFN 000R X Prof Li ab GEWERA AGGREGATE� a 3200010 MNL AGWMQATE UAASTAI'PLIES PEft PraDDUGr POL . GQ�MRI9p AGG $ j•NCLW ICY O- -- JEPR8, LOC AU70fIMOBILE�NWW ...._. COMI&MiED $7NL LIMIT AW ALL OWNEOAUTOS 8C:K, Fb AUTOS p ,INJURY b i OWED A'UTUS NONL�bdlVEO AL3T05 ((Pef 6 I) $ PROPERTY DAMAGE (Psr a�idrnt) GARAGE LIAMUrY ! � AAPfOONL'v b F,.AACClOtrNf $ AW A.V I C -� -- - -- 7T?IER THAIk EA ACC S AUTO ONLY! AGG S EXC9 IW4ftL1AUABILRY a:ACNOF:i:URRENCE a 5 -- OCCUR LJ C::L.AA)LS MAGE ACGREGATE��,.. DEDUCTeLF I S RETENTION "URKEM COIMPENZA710NAND ��-7T8ii00 12/03/2004 12/03/20flS X A u- - EAiI+6DYER3' L11HMY ANY PROFWPFr RJPAFTHkWV0X ?IVE EL TACH AMIUGNT 100 000 OFF9C&RV*M9fiit EXCLUOM'T Fri, ae=wo ur rr �IE L OISEA3e - EA ZWLOYEE 9 500 , OK 6 ECLAL PROVISIO $ oe;Ww - - El DI$EAkE^ PO: ICY UWr $ 100 LPT"EAPSa90421/23200J erexeal /Physical Abuse I , A 150 , 000 aggregate OESCRIP'F14N i7F OFW1710Rs r Lar,R'7KIN3 r 7IFbNCi.&b l NS ADDED BY FROMSEWIMT I SKOIAL PROVP31ONG ertificate ^alder is listed as a r7lb"0lal insured with respect to General Liability as respect to und'i ng onl y . IFS HIDER CANCi<LLATjQN s?'IO(IL0 WY OF THE ABOVE Okal,CFWPU POM" BE C.ANCULED bero E TTYE EVIRATION DATE TwiCOF, THE gIiW4INSURER POLL ENDEAVOR TO MAL 10 O4Y'6 VYCTIrm wixE TO TNF CERTTw: ATE IW k,ow N"20 TO T"z LEFT. Indian River County Board of Comi 3sioners NUr FALURE TO IrMLSUCH NOTUS SNALA, WPM NO ObLIGA'nON OR LVJULFTY 1940 25th Street OFAXY ILM UPOM THE WBURER, Irg Ar"T& OR REPIMSSENTATWES. Vero Beach , FL 32960- 3365 RyFHORREDIt6)i9klENTATIIlE — _.__ . - Kc Ima!th I) . Felten = LLMC?-/]d3C � WACORD CORPORATION 1.98# 11 : 13 AM DASIE BRIDGEWATER HOPE CENTER INC 05/17/05 Profit & Loss by Class Accrual Basis January through April 2005 Basketball Camp Business Program Crab Fest Operating Fund TOTAL Income General Donations 0.00 0 . 00 0 . 00 13 ,599. 88 133599 . 88 Grants Grand Harbor 0. 00 82000 . 00 0.00 0 . 00 81000 . 00 Indian River County 0. 00 0 . 00 0.00 14, 113 . 01 14 , 113 . 01 Johns Island Service League 0. 00 0 . 00 0 . 00 10,000 . 00 10 ,000 . 00 United Way 0. 00 0 . 00 0. 00 14,666 . 64 14 , 666. 64 Total Grants 0 .00 81000 .00 0 .00 38, 779 . 65 46 ,779 . 65 Interest Income 0.00 0. 00 0.00 30 .41 30 .41 Sponsors 0. 00 0. 00 1 ,750 .00 0 . 00 13750 . 00 Ticket Sales 0.00 0 . 00 11136 . 00 0 . 00 11136. 00 Total Income 0 .00 81000 . 00 21886 . 00 52 ,409.94 63 , 295 . 94 Expense Advertising 0. 00 0.00 50.00 0 . 00 50 . 00 Awards & Plaques 0 . 00 0.00 0.00 43 . 00 43 . 00 Bank Charges 0 .00 0.00 0 .00 1 . 03 1 . 03 Books & Educational Materials 0 . 00 68. 84 0 . 00 25 . 80 94 . 64 Dues & Subscriptions 0 . 00 0. 00 0 . 00 95. 60 95 . 60 Equipment 0 . 00 0 . 00 0 . 00 49 . 97 49. 97 Equipment Lease 0 . 00 0 . 00 0 . 00 10 .22 10 . 22 Equipment Rental 0.00 0 .00 65 .00 36.00 101 . 00 Food 0. 00 48.46 21955. 12 874.46 3 , 878 . 04 Fundraising Expense 0. 00 0 . 00 0 . 00 589.72 589. 72 Insurance 0. 00 0 . 00 0 . 00 59838 .72 51838. 72 Office Supplies 0. 00 0 . 00 0 . 00 11486 . 03 1 ,486.03 Payroll Expenses 0 .00 0 . 00 0 . 00 0. 00 0 .00 Payroll Tax Expense 0 . 00 0 . 00 0 . 00 41283 . 27 4 ,283 .27 Playground 0.00 0 . 00 0 . 00 19351 .25 11351 .25 Professional Fees 0.00 0 . 00 0 . 00 250. 00 250.00 Repairs & Maintenance 0 . 00 0 . 00 0.00 10976.27 11976.27 Salaries - Other 0 . 00 0.00 0 .00 40, 171 .58 40 , 171 . 58 Specific Assistance to Individu 0 . 00 0 .00 0 . 00 400 . 00 400 . 00 Supplies 655 . 38 175.00 379. 23 739. 01 11948 . 62 Taxes & Licesnses 0. 00 0 . 00 0 . 00 137 . 50 137 .50 Telephone 0. 00 0 . 00 0 . 00 671 . 04 671 . 04 Transportation 0.00 0 . 00 0 . 00 20 . 00 20 .00 Travel 0 . 00 21412. 67 0 . 00 21178 . 26 41590 . 93 Tutor 0 .00 0 .00 0. 00 377. 00 377 . 00 Unknown 0 . 00 0 . 00 0 .00 271 .00 271 . 00 Utilities 0. 00 0 . 00 0 . 00 820.66 820. 66 Total Expense 655 . 38 21704 . 97 39449. 35 62 ,697 . 39 69, 507 . 09 Net Income -655.38 5,295. 03 -563. 35 -10,287.45 -6,211 . 15 Pagel 11 : 13 AM DASIE BRIDGEWATER HOPE CENTER INC 05/17/05 Balance Sheet Accrual Basis As of April 30 , 2005 Apr 30 , 05 ASSETS Current Assets Checking/Savings Checking - IRNB 823 . 78 Checking - Savings 19, 147.65 Total Checking/Savings 19, 971 .43 Other Current Assets Accounts Receivable 500 .00 Petty Cash 11360. 00 Total Other Current Assets 1 , 860 . 00 Total Current Assets 21 , 831 .43 Fixed Assets Computers 11649. 52 Furniture 81031 . 01 Machinery & Equipment 5, 376. 00 Total Fixed Assets 15, 056. 53 Other Assets Security Deposit 240 . 00 Total Other Assets 240. 00 TOTAL ASSETS 37, 127. 96 LIABILITIES & EQUITY Liabilities Current Liabilities Other Current Liabilities FWT & SS Payable 21413 . 78 Payroll Liabilities -222.42 Total Other Current Liabilities 21191 .36 Total Current Liabilities 2, 191 . 36 Total Liabilities 21191 . 36 Equity Retained Earnings 41 , 147. 75 Net Income -6, 211 . 15 Total Equity 34 , 936. 60 TOTAL LIABILITIES & EQUITY 37, 127.96 Page 1 EXHIBIT B ( From policy adopted by Indian River County Board of county Commissioners on February 19 , 2002 ) " D . Nonprofit Agency Responsibilities After Award Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year and (September 30th) must be submitted on a timely basis . Each year, the Office of Management and Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expense by type . These summaries should be broken down into salaries , benefit , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a ) Travel expenses for travel outside the County including but not limited to : mileage reimbursement , hotel rooms , meals , meal allowances , per diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b) Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c) Any expenses not associated with the provision of the program for which the County has awarded funding . d ) Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " EXHIBIT - B - I EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices . Any notice , request, demand , consent , approval , or other communication required or permitted by this Contract shall be given , or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston-Carlson , Director Indian River County Human Services 1840 25th Street Vero Beach , Florida 32960-3365 Recipient : Dasie Bridgewater Hope Center P . O . Box 701483 Wabasso , Florida 32970 2 . Venue : Choice of Law. The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian River county, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement . This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability. In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other provision and term of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent , this Contract is deemed severable . 5 . Captions and Interpretations . Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless context indicates otherwise , words importing the singular number include the plural number, and vise versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract . The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient 's sole direction , supervision and control . 7 . Assignment . This Contract may not be assigned by the Recipient without the prior written consent of the County . EXHIBIT - C - 10 - Z $ ' U5 FRI 10 ; 37 FAX 7722311413 FELTEN & ASSOC , 0 (12 ' jQRA CERTIFICATE OF LIA13ILITY INSURANCE � i�rmw� �n _ . . PNOouCEn (772) 231 w2021 FAX 772) 231 -4413 THIS CERTIFICATE IS ISSIUEU AS A 04ATTER OF INFORMATION Fel ten & Asso"ciates" ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7911. Cardinal Drive (32963) HOLAER. THIS CERTIFICATE DOES NOT AMEND) EXTEND OR P . O : Box 3488 ALTER TNS Gt1 TRAGF AFFC)RDED NIX THE POLICES BELOW. Vera Bleach , FL 32964-3488 INSURERS AFFORDING COVERAGE NAiC 0 Iwsur ,� Bwidaater Floe Center Inc _ --�-- ------ — _ _-_ ----- ---i..- ._ _ __ IN5URERA: Colorry Insurance Company pan 8445 64th Ave _.�. _. -.. - - - _ INs �RB Florida Retail Federation Wabasso , FL 32970 - INsUCPRC 171E POLICIES OF IYSUI RANGE USTED BELOW itAVE BEEN ISSUED TO THE INSURED NAMP Ab(AvE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANID(NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TC WHICH THIS CER71FICATE MAY 8F ISSUIF0 OR MAY MRTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E)(CLUSIONS AND CONDITIONS OF SUCH POLICIES,. AGGREGATE LIMITS_ SHOWN MA.Y HAVE BEEN RFDUCF0 BY PAD C4ANS. 11I�R — 7YP4 OF INSURANCE POLICY NUMIBf3f POMICY T- L Mrr$ 1 GENERALUABUffY ._.. -�._. - - AETS08042 1241231266V11 ail z00 's eA~MOCC $ —J, 000 , 0 X 0OWERCLAL Ct1YERAt L ABILITY DAMAGE TO RENTT D 0001 �Lftffi MADE F l OCCUR MED Ftp (F�ryore F•araan) J( � li1F A X 5000 ded per ,claim PeRsoweLa ADV NJUFN 000R X Prof Li ab GEWERA AGGREGATE� a 3200010 MNL AGWMQATE UAASTAI'PLIES PEft PraDDUGr POL . GQ�MRI9p AGG $ j•NCLW ICY O- -- JEPR8, LOC AU70fIMOBILE�NWW ...._. COMI&MiED $7NL LIMIT AW ALL OWNEOAUTOS 8C:K, Fb AUTOS p ,INJURY b i OWED A'UTUS NONL�bdlVEO AL3T05 ((Pef 6 I) $ PROPERTY DAMAGE (Psr a�idrnt) GARAGE LIAMUrY ! � AAPfOONL'v b F,.AACClOtrNf $ AW A.V I C -� -- - -- 7T?IER THAIk EA ACC S AUTO ONLY! AGG S EXC9 IW4ftL1AUABILRY a:ACNOF:i:URRENCE a 5 -- OCCUR LJ C::L.AA)LS MAGE ACGREGATE��,.. DEDUCTeLF I S RETENTION "URKEM COIMPENZA710NAND ��-7T8ii00 12/03/2004 12/03/20flS X A u- - EAiI+6DYER3' L11HMY ANY PROFWPFr RJPAFTHkWV0X ?IVE EL TACH AMIUGNT 100 000 OFF9C&RV*M9fiit EXCLUOM'T Fri, ae=wo ur rr �IE L OISEA3e - EA ZWLOYEE 9 500 , OK 6 ECLAL PROVISIO $ oe;Ww - - El DI$EAkE^ PO: ICY UWr $ 100 LPT"EAPSa90421/23200J erexeal /Physical Abuse I , A 150 , 000 aggregate OESCRIP'F14N i7F OFW1710Rs r Lar,R'7KIN3 r 7IFbNCi.&b l NS ADDED BY FROMSEWIMT I SKOIAL PROVP31ONG ertificate ^alder is listed as a r7lb"0lal insured with respect to General Liability as respect to und'i ng onl y . IFS HIDER CANCi<LLATjQN s?'IO(IL0 WY OF THE ABOVE Okal,CFWPU POM" BE C.ANCULED bero E TTYE EVIRATION DATE TwiCOF, THE gIiW4INSURER POLL ENDEAVOR TO MAL 10 O4Y'6 VYCTIrm wixE TO TNF CERTTw: ATE IW k,ow N"20 TO T"z LEFT. Indian River County Board of Comi 3sioners NUr FALURE TO IrMLSUCH NOTUS SNALA, WPM NO ObLIGA'nON OR LVJULFTY 1940 25th Street OFAXY ILM UPOM THE WBURER, Irg Ar"T& OR REPIMSSENTATWES. Vero Beach , FL 32960- 3365 RyFHORREDIt6)i9klENTATIIlE — _.__ . - Kc Ima!th I) . Felten = LLMC?-/]d3C � WACORD CORPORATION 1.98#